Back to the Future with Health Care

Most regrettably, several conservative Republicans in the U.S. House would not support the American Health Care Act (AHCA), and thus the bill was pulled by Speaker of the House Paul Ryan, after informing the president that there were an insufficient number of votes to pass the bill. This process became a boondoggle that should never have happened.

The AHCA, after several negotiated iterations, between moderate and conservative Republicans, and the president, was actually, as President Trump said, “a very, very, good bill” – contrary to what so many Republican voters were led to believe through media reports and the conservative Freedom Caucus House members, during the negotiation process.

The bill eliminated $1 trillion dollars of Obamacare taxes, penalties, and fees. It shifted responsibility for managing Medicaid, which was expanded under Obamacare, to the respective states. It allowed each state to determine essential coverage benefits under health care insurance policies. In addition, the bill defunded Planned Parenthood, a long-standing aim of conservatives.

The bill did not establish a free market health care system, permitting the sale of health insurance policies across state lines, to create competition and reduce prices, as including this, and any other policy changes, would have negated passage of the bill by the U.S. Senate with a mere 51 votes, instead of the general legislation threshold of 60 votes – which Republicans do not have (See the Stewardship America article “Repealing and Replacing Obamacare – the Only Way,” for a full discussion on this point.). Herein lies the reason for the often misunderstood Ryan 3-step repeal process.

Obamacare was constructed in a rather complex manner; and without 60 votes in the senate, it can only be repealed and replaced, or “deconstructed,” in a similar manner. So the question at this point is, “Now what?”

Despite any political rhetoric to the contrary, nothing has changed in terms passing a health care repeal bill through the U.S. Senate. The only bill that can pass must do so under the “Reconciliation” rules in the Senate, which limits legislation to budgetary items, and by virtue thereof, only requires a simple majority of 51 senate votes.

At this point, it’s “back to the future.” House Republicans are already discussing reviving the health care bill, after their collective failure, led by the intractable Freedom Caucus, who were granted almost every demand, but nonetheless kept “moving the goalpost,” until the president finally said, in effect, “Enough!”

Anyone who understands basic economics wants a free-market health care insurance and medical system in America. The preferred approach would be to accomplish this desired end state in one legislative act which passes both houses of congress. This was, and remains, impossible with 52 Republican senate votes.

What is possible is to defund Obamacare immediately; and give the president and Health and Human Services Secretary Dr. Tom Price the “scalpel” they can use in the form of executive authority to deconstruct a whopping 1,442 Obamacare regulations, and move the nation closer to a free market health care system. In short, Republicans should revive and pass the bill under Reconciliation, and give the president the “football” to carry across the free-market goal line.